[Effectiveness of the "14 plus 7 day quarantine" and "nucleic acid plus total antibody testing" strategy for screening imported patients with COVID-19 in Xiamen]

Objective: To analysis effectiveness of the "14 plus 7 day quarantine" and "nucleic acid plus total antibody testing" strategy (combined screening strategy) for screenin the imported patients with COVID-19 in Xiamen. Methods: The study populations were overseas travelers arriving in Xiamen from March 17 to December 31, 2020, and overseas travelers who had quarantine outside Xiamen for less than 21 days from July 18 to December 31, 2020. Data were collected and analyzed on the timing of detection, pathways, and test results of the imported patients with COVID-19 after implementing combined screening strategy. Results: A total of 304 imported patients with COVID-19 were found from 174 628 overseas travelers and 943 overseas travelers from other cities. A total of 163 cases (53.6%) were diagnosed by multitime, multisite intensive nucleic acid testing after positive finding in total antibody testing. Among them, 27 (8.9%) were first positive for nucleic acid in 14 plus 7 day quarantine and 136 were first positive for nucleic acid in 14-day quarantine. Only 8 of these individuals were tested positive for nucleic acid after positive total antibody testing. The other 128 individuals were tested positive for nucleic acid after being negative for average 2.3 times (maximum of 6 times). Aditional 155 cases might be detected by using the combined "14 plus 7 day quarantine" and " nucleic acid plus total antibody testing" strategy compared with "14-day quarantine and nucleic acid testing" strategy, accounting for 51.0% of the total inbound infections. So the combined screening strategy doubled the detection rate for imported patients with COVID-19. No second-generation case caused by overseas travelers had been reported in Xiamen as of February 26, 2021. Conclusions: Xiamen's combined screening strategy can effectively screen the imported patients with COVID-19 who were first positive for nucleic acid after 14 day quarantine. Compared with "14 day quarantine and nucleic acid testing", the combined screening strategy improved detection rate and further reduced the risk of the secondary transmission caused by the imported patients with COVID-19.

A simple method for moving source depth estimation applied to the SWellEx96 data

Existing methods for source localization in an ocean waveguide generally require simultaneous range and depth estimation as they are intrinsically coupled in the acoustic field. Using beam intensities averaged over ranges longer than the mode cycle distances, it is shown that the range-averaged vertical beam distribution is insensitive to the source range and sensitive to the source depth. An incoherent matched beam processing method is presented and applied to the SWellEx96 moving source data to estimate source depth based on the 127 and 130 Hz signals with good results.

Beam-time delay domain deconvolved scheme for high-resolution active localization of underwater targets

Matched filter (MF) and conventional beamforming (CBF) are widely used in active sonar; the performance of the former (temporal resolution) is limited by the signal bandwidth, and that of the latter (angular resolution) is limited by the array aperture. Previous work has shown that angular resolution can be significantly improved by deconvolving the CBF outputs. In this paper, deconvolution is extended to the time domain by deconvolving the MF outputs, and a high-resolution two-dimensional deconvolution method is proposed to simultaneously improve the temporal and angular resolution. Numerical simulations and experimental tank data show that angular resolutions are improved 26 times, and temporal resolutions are improved 10 times compared with the conventional MF and CBF methods. Reverberations are much suppressed to allow target echoes to be detected from the received time series data.

Deconvolution of decomposed conventional beamforming

A recently proposed deconvolution method applied to conventional beamforming (CBF) shows a much higher array gain (AG) than CBF in theory, thereby providing the possibility for detecting a weak signal with a much lower signal-to-noise ratio (SNR). However, simulated data processing shows an effective AG that decreases with decreasing SNR. The reason for the performance loss is analyzed. A method based on deconvolution of the signal subspace of the CBF outputs is shown to recover most of the AG loss. It is used to trace a weak signal in bearing and time.

Matched beam-intensity processing for a deep vertical line array

A vertical line array can be deployed in deep water below the critical depth, the depth where the sound speed equals the sound speed at the surface, to take advantage of the lower ambient noise level (compared with above the critical depth) for target detection. To differentiate a submerged source from a surface source, a Fourier transform based method [McCargar and Zurk, J. Acoust. Soc. Am. 133, EL320-325 (2013)] was proposed for a narrowband signal that exploits the depth-related harmonic (oscillation) feature of the beam power time series associated with the target arrival. In this paper, incoherent matched beam processing is used to estimate the target depth. Where the replica (calculated) beam intensity or amplitude time series best matches that of the data is used to estimate the source depth. This method is shown, based on simulated data, to provide a better depth resolution in general and better ability to estimate the depth of a very shallow source (say at 10 m) and can be used to complement the Fourier transform based method. It can be extended to process (random) broadband signals and to environments where the Lloyd's mirror theory is not valid.

Joint towed array shape and direction of arrivals estimation using sparse Bayesian learning during maneuvering

Large aperture towed arrays are widely used underwater to detect weak targets. During maneuvering, the beamformer performance degrades significantly if a wrong array configuration is assumed. Currently, engineering sensors and/or (augmented) acoustic sources are used to estimate the array element positions. The results are often inadequate depending on the number of measurements available. In this paper, an adaptive bow (AB) sparse Bayesian learning (SBL) algorithm is proposed, called ABSBL. Assuming the towed array follows a parabola shape during slow turns and treating the array bow as a hyperparameter in SBL, the bow and directions of arrival (DOAs) of the signals can be jointly estimated from the received acoustic data. Simulations show that ABSBL yields accurate estimates of the bow and target DOAs if the turning direction is known. ABSBL is applied to the MAPEX2000 data. The estimated array bow and DOA agrees with that estimated from relative time delays measured from acoustic pings and SBL, better than that estimated from the GPS data using the water-pulley model. The method can potentially be applied without engineering sensors.

Channel distortion on target scattering amplitude in shallow water

Bistatic acoustic scattering uses echo returns from a target to estimate the scattered intensity or amplitude as a function of angle and frequency (acoustic color) for target classification. In a shallow water waveguide, the echo return from a target at a distance, such as a mine, is modified by the waveguide and deviates significantly from that at close range or in free space. The channel effect or distortion on the echo return is studied using simulated data. A simple frequency domain signal processing method is proposed to equalize the channel effect. The frequency and angle distribution of the estimated scattering function is compared with that of the original function. It is found to be an adequate representation of the original function with a high correlation coefficient (∼0.88).

Source localization in range-dependent and time-varying shallow water: The Shallow Water 2006 experimental results

In a range-dependent and time-varying environment, such as at the Shallow Water 2006 (SW06) experimental site, matched field processing often has difficulty localizing a moving source emitting a narrowband signal when signal mismatch is difficult to mitigate given only the nominal sound speed profile and bottom properties along the source track. Based on the range-averaged mode wavenumbers and depth functions estimated from data received on a vertical line array by synthetic beamforming (without any environmental information) using Doppler shift as a reference, a method is proposed in this paper to search for the source depth first and then the source range. Source localization is demonstrated with the SW06 data for two source runs along and oblique to the shelf. Robustness is achieved by minimizing/breaking the coupling between range and depth, when one of them can be estimated using non-environment-related input.

Array gain of coprime arrays

A coprime array of M + N - 1 elements is designed, using product processing (PP), to yield the same beam width as that of a full array of MN elements using conventional beamforming (CBF), while at the same time suppressing the grating lobes. The array gain (AG) for isotropic noise using conventional PP is slightly less than that obtained using CBF, namely, 10log(M + N - 1). It is shown that using the coherent product processing, the coprime array yields an AG equal to that of the full array of MN elements, 10log(MN). The superior gain is often referred to as supergain.

Superdirective beamforming applied to SWellEx96 horizontal arrays data for source localization

Arrays employing superdirective beamforming can provide the same directivity and directivity index (or array gain) with less aperture as a large size array using conventional beamforming (CBF). Superdirective arrays offer a practical and significant improvement in the reception of low frequency signals and is useful for many applications where the array size is limited, such as a miniature microphone array or an underwater acoustic array with a limited aperture. Deconvolving the CBF is a method of superdirective beamforming. The improvement in directivity (beam width) and array gain is studied/illustrated using the SWellEx96 horizontal array data where only sub-arrays are used.

The association between body mass index, primary healthcare use and morbidity in early childhood: findings from the Born In Bradford cohort study

OBJECTIVES

The objective of the article was to examine the association between body mass index (BMI), health and general practice (GP) healthcare use in early childhood.

STUDY DESIGN

This study is a prospective cohort study.

METHODS

Multivariate Poisson and logistic regression models were used to explore the association between BMI and health outcomes using data from the Born In Bradford cohort study, linked to routine data capturing objective measures of BMI at age 5 years, alongside GP appointment rates, GP prescriptions and specific morbidities in the subsequent 3-year period.

RESULTS

Compared with healthy weight, children who were obese at the age of 5 years had significantly higher rates of GP appointments (incident rate ratio 1.14, 95% confidence interval [CI]: 1.06-1.23), GP prescriptions (incident rate ratio 1.15, 95% CI: 1.04-1.27), asthma (odds ratio 1.46, 95% CI: 1.21-1.77), sleep apnoea (odds ratio 2.50, 95% CI: 1.36-4.58), infections (incident rate ratio 1.19, 95% CI: 1.08-1.30), antibiotic prescriptions (incident rate ratio 1.25, 95% CI: 1.10-1.42) and accidents (incident rate ratio 1.20, 95% CI: 1.01-1.42) in the subsequent 3 years. Underweight children were found to have higher rates of GP appointments (incident rate ratio 1.25, 95% CI: 1.04-1.52), but there were no differences between overweight and healthy weight children.

CONCLUSIONS

Childhood obesity was found to be associated with increased primary healthcare use and a range of poorer health outcomes at the age of 8 years, underlining the importance of reducing childhood obesity in early childhood.

Physics-based coastal current tomographic tracking using a Kalman filter

Ocean acoustic tomography can be used based on measurements of two-way travel-time differences between the nodes deployed on the perimeter of the surveying area to invert/map the ocean current inside the area. Data at different times can be related using a Kalman filter, and given an ocean circulation model, one can in principle now cast and even forecast current distribution given an initial distribution and/or the travel-time difference data on the boundary. However, an ocean circulation model requires many inputs (many of them often not available) and is unpractical for estimation of the current field. A simplified form of the discretized Navier-Stokes equation is used to show that the future velocity state is just a weighted spatial average of the current state. These weights could be obtained from an ocean circulation model, but here in a data driven approach, auto-regressive methods are used to obtain the time and space dependent weights from the data. It is shown, based on simulated data, that the current field tracked using a Kalman filter (with an arbitrary initial condition) is more accurate than that estimated by the standard methods where data at different times are treated independently. Real data are also examined.

Estimating the delay-Doppler of target echo in a high clutter underwater environment using wideband linear chirp signals: Evaluation of performance with experimental data

A chirp signal is a signal with linearly varying instantaneous frequency over the signal bandwidth, also known as a linear frequency modulated (LFM) signal. It is widely used in communication, radar, active sonar, and other applications due to its Doppler tolerance property in signal detection using the matched filter (MF) processing. Modern sonar uses high-gain, wideband signals to improve the signal to reverberation ratio. High gain implies a high product of the signal bandwidth and duration. However, wideband and/or long duration LFM signals are no longer Doppler tolerant. The shortcoming of the standard MF processing is loss of performance, and bias in range estimation. This paper uses the wideband ambiguity function and the fractional Fourier transform method to estimate the target velocity and restore the performance. Target velocity or Doppler provides a clue for differentiating the target from the background reverberation and clutter. The methods are applied to simulated and experimental data.

Data-based depth estimation of an incoming autonomous underwater vehicle

The data-based method for estimating the depth of a moving source is demonstrated experimentally for an incoming autonomous underwater vehicle traveling toward a vertical line array (VLA) of receivers at constant speed/depth. The method assumes no information on the sound-speed and bottom profile. Performing a wavenumber analysis of a narrowband signal for each hydrophone, the energy of the (modal) spectral peaks as a function of the receiver depth is used to estimate the depth of the source, traveling within the depth span of the VLA. This paper reviews the theory, discusses practical implementation issues, and presents the data analysis results.

Vitamin E homologues α- and γ-tocopherol are not associated with bone turnover markers or bone mineral density in peri-menopausal and post-menopausal women

In a large cohort of older women, we investigated the relationships that different forms of vitamin E may have with bone turnover markers and bone mineral density (BMD). We found a suggestive positive association between serum alpha-tocopherol and BMD at the femoral neck, but no other clinically relevant observations.

INTRODUCTION

Vitamin E has anti-oxidant and anti-inflammatory properties hypothesized to benefit bone, but limited studies exist regarding its homologues. We examined circulating and dietary α- and γ-tocopherols with bone turnover markers (BTMs) and bone mineral density (BMD), and the role of inflammation in this relationship.

METHODS

We performed two cross-sectional analyses from two visits (V2, 1997-1999, n = 3883; V3, 2007-2011, n = 2130) of the Aberdeen Prospective Osteoporosis Screening Study. Dietary and supplement intakes by food frequency questionnaire were assessed at both visits. V2 BTMs (urinary free pyridinoline and deoxypyridinoline, serum N-terminal propeptide of type 1 collagen) and V3 serum α- and γ-tocopherols, inflammatory markers (interleukin-6 [IL-6], serum amyloid A [SAA], high-sensitivity C-reactive protein [hs-CRP], E-selectin) and dual X-ray absorptiometry BMD at the femoral neck and lumbar spine were collected. Food sources of tocopherol homologues and diet-serum correlations were determined. The relationships between dietary tocopherols and BTMs (V2), and dietary and serum tocopherols with BMD (V3) were examined by multivariable regression (adjusting for age, cholesterol, inflammatory markers, carotenoids, body mass index, physical activity level, alcohol intake, smoking status and national deprivation category).

RESULTS

Serum γ-tocopherol was associated with increasing concentrations of hs-CRP, SAA and E-selectin (P-trend all <0.0001), while α-tocopherol was associated with decreasing concentrations of IL-6 and hs-CRP (P-trend all <0.001). Controlling for covariates, serum α-tocopherol was positively associated with BMD at the femoral neck (β = 0.002, P = 0.04) among those not reporting vitamin E supplementation.

CONCLUSION

We did not find biologically meaningful results between dietary and tocopherol homologues with BTMs or BMD.

End Stage Renal Disease as a Potential Risk Factor for Retinal Vein Occlusion

End stage renal disease (ESRD) has been reported to be an important risk factor for systemic vascular disease. Retinal vein occlusion (RVO) is closely related with cardiovascular diseases; however, its association with ESRD had not been reported. The aim of the study was to investigate whether ESRD is a risk factor for RVO, including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). This population-based study is based on the longitudinal data from Taiwan National Health Insurance Research Database. The study cohort comprised 5344 patients with diagnosis of ESRD on hemodialysis or peritoneal dialysis during the period from January 1996 to December 2011. For each ESRD patient, we selected 20 non-ESRD patients matched on age and sex. Each ESRD patient and his/her controls were followed from the initiation of renal dialysis until either the diagnosis of RVO or censorship. Kaplan-Meier method was used to compare the hazard of RVO between cohorts. Stratified Cox proportional hazard models were applied to estimate the hazard ratio (HR) adjusted by the comorbidities of RVO including diabetes mellitus (DM), hypertension, hypercholesteremia, and hypertriglyceridemia. After stratifying by DM status, the statistics were applied again to examine the associations among the DM cohort and non-DM cohort.The 16-year RVO cumulative incidence for ESRD cohort was 2-fold to the non-ESRD (1.01% vs 0.46%). After matching with age, sex, hypertension, and hypercholesteremia, the adjusted HR was 1.46 (95% confidence interval = 1.07-2.01, P value = 0.018). By further excluding patients with DM, the adjusted HR escalated to 2.43 (95% confidence interval = 1.54-3.83, P < 0.001). In contrast, there was no significant risk of ESRD on RVO in the DM patients (HR = 1.03). We conclude that among the non-DM patients, ESRD cases had significantly higher RVO rate than the non-ESRD, which indicates that ESRD maybe a potential risk factor for the development of RVO in nondiabetic patients.

Source depth estimation based on synthetic aperture beamfoming for a moving source

A continuous wave signal received on a single hydrophone from a moving source is beamformed using the synthetic aperture created by the source, where the signal at each range is steered by a range-dependent phase, relative to the starting point. The range increment (aperture) is determined based on the Doppler shift estimated from the data, knowing the original signal frequency. Given a sufficient signal-to-noise ratio, the source depth can be estimated from the beam output, assuming knowledge of the mode depth functions based on the nominal sound speed and bottom profile in the area. The method is illustrated with simulated data and at-sea data. For real data, the signal phase contains a random, incoherent component caused by the (random) source motion and media fluctuations in addition to the deterministic range-dependent component due to source range change. A phase locked loop is introduced to remove the random component assuming that the random component fluctuates faster with time than the range-dependent phase. When a vertical array of receivers are available covering the depth span of interest, the beam output can be used directly to estimate the source depth. In this case, no knowledge of the acoustic environment is needed.

Nonapnea sleep disorders and incident chronic kidney disease: a population-based retrospective cohort study

Nonapnea sleep disorders (NASDs) are associated with an increased risk of stroke, diabetes, and hypertension. No longitudinal study has yet examined the association between NASD and chronic kidney disease (CKD) by using epidemiologic study methods. To test this hypothesis, we examined the effect of NASD on the incidence of CKD in a large population-based retrospective cohort study. Based on a retrospective cohort study of a general population sample of 128 to 436 patients in the Taiwan National Health Insurance Research Database from January 1, 1998 to December 31, 2001, 42 to 812 NASD patients were followed up for 10.2 ± 3.12 years, and additional 85 to 624 individuals had no NASD at baseline. The International Classification of Diseases, Ninth Revision, Clinical Modification was used to identify the diagnosis of disease. Cox proportional hazard regression models were used to assess the association between NASD and subsequent CKD risk. The incidence rate of CKD was significantly higher in the NASD cohort than in the comparison cohort (2.68 vs 1.88 per 1000 person-years, respectively). After we adjusted for age, sex, and comorbidities, the risk of developing CKD was significant for patients with NASD (adjusted hazard ratio [HR] = 1.13; 95% confidence interval [CI] = 1.05-1.22; P < 0.01). Among different types of NASDs, patients with sleep disturbance associated disorders had a 14% increased risk of developing CKD (95% CI = 1.03-1.26; P < 0.01), whereas patients with insomnia had a 13% increased risk of subsequent CKD (95% CI = 1.02-1.25; P < 0.05) compared with the non-NASD cohort. Kaplan-Meier survival analysis indicated that the CKD-free rate was 1% lower in the NASD cohort than in the comparison cohort (log-rank test, P < 0.0001). Our study provides evidence that patients with NASD have an increased risk of developing subsequent CKD compared with patients without NASD; men, elderly people, and patients with concomitant comorbidities are at the greatest risk.

Mycelia glycoproteins from Cordyceps sobolifera ameliorate cyclosporine-induced renal tubule dysfunction in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Cordyceps sorbolifera has been used in Traditional Chinese Medicine for improving the renal function. Cyclosporine A (CsA) is an important immunosuppressive agent in the prevention of renal allograft rejection, but long-term usage of CsA could lead to chronic nephrotoxicity and renal graft failure. The study was aimed to investigate whether the mycelia glycoproteins of Cordyceps sobolifera (CSP) exert prevention effects on CsA-induced nephrotoxicity.

MATERIALS AND METHODS

Sprague-Dawley (SD) rats were randomly assigned into four groups (n=6 per group): normal saline (control group), CSP group, CsA group, and CSP-CsA group (CsA combined treatment with CSP). Glomerular and tubular functions were assessed and histological studies were performed.

RESULTS

CSP, prepared by hot water extraction, ethanol precipitation and membrane dialysis, was found to be composed of three glycoproteins with average molecular weights of 543, 31, and 6.3 kDa, respectively. CsA impaired urea clearance and creatinine clearance were significantly improved by concomitant administration of CSP. TUNEL histochemical stain revealed that CSP significantly decreased CsA-induced apoptosis in renal tubular cells. The reducing effect of caspase-3 activation by CSP was suggested through the over-expression of the anti-apoptosis protein Bcl-2 in renal tubule cells. In assessment of CSP protection of renal tubule function, we found that CSP restored CsA induced magnesium wasting by increasing the magnesium reabsorption channels TRMP6 and TRMP7.

CONCLUSION

The results suggested that CSP had a significant suppressive activity on CsA-induced apoptosis and protective activity against nephron loss possibly via its restoring activity by increasing the magnesium reabsorption channels TRMP6 and TRMP7 on CsA induced magnesium wasting.

Data-based matched-mode source localization for a moving source

A data-based matched-mode source localization method is proposed in this paper for a moving source, using mode wavenumbers and depth functions estimated directly from the data, without requiring any environmental acoustic information and assuming any propagation model. The method is in theory free of the environmental mismatch problem because the mode replicas are estimated from the same data used to localize the source. Besides the estimation error due to the approximations made in deriving the data-based algorithms, the method has some inherent drawbacks: (1) It uses a smaller number of modes than theoretically possible because some modes are not resolved in the measurements, and (2) the depth search is limited to the depth covered by the receivers. Using simulated data, it is found that the performance degradation due to the afore-mentioned approximation/limitation is marginal compared with the original matched-mode source localization method. The proposed method has a potential to estimate the source range and depth for real data and be free of the environmental mismatch problem, noting that certain aspects of the (estimation) algorithms have previously been tested against data. The key issues are discussed in this paper.

Acoustic mode coupling induced by nonlinear internal waves: evaluation of the mode coupling matrices and applications

This paper applies the mode coupling equation to calculate the mode-coupling matrix for nonlinear internal waves appearing as a train of solitons. The calculation is applied to an individual soliton up to second order expansion in sound speed perturbation in the Dyson series. The expansion is valid so long as the fractional sound speed change due to a single soliton, integrated over range and depth, times the wavenumber is smaller than unity. Scattering between the solitons are included by coupling the mode coupling matrices between the solitons. Acoustic fields calculated using this mode-coupling matrix formulation are compared with that obtained using a parabolic equation (PE) code. The results agree very well in terms of the depth integrated acoustic energy at the receivers for moving solitary internal waves. The advantages of using the proposed approach are: (1) The effects of mode coupling can be studied as a function of range and time as the solitons travel along the propagation path, and (2) it allows speedy calculations of sound propagation through a packet or packets of solitons saving orders of magnitude computations compared with the PE code. The mode coupling theory is applied to at-sea data to illustrate the underlying physics.

Acoustic mapping of ocean currents using networked distributed sensors

Distributed underwater sensors are expected to provide oceanographic monitoring over large areas. As fabrication technology advances, low cost sensors will be available for many uses. The sensors communicate to each other and are networked using acoustic communications. This paper first studies the performance of such systems for current measurements using tomographic inversion approaches to compare with that of a conventional system which distributes the sensors on the periphery of the area of interest. It then proposes two simple signal processing methods for ocean current mapping (using distributed networked sensors) aimed at real-time in-buoy processing. Tomographic inversion generally requires solving a challenging high dimensional inverse problem, involving substantial computations. Given distributed sensors, currents can be constructed locally based on data from neighboring sensors. It is shown using simulated data that similar results are obtained using distributed processing as using conventional tomographic approaches. The advantage for distributed systems is that by increasing the number of nodes, one gains a much more improved performance. Furthermore, distributed systems use much less energy than a conventional tomographic system for the same area coverage. Experimental data from an acoustic communication and networking experiment are used to demonstrate the feasibility of acoustic current mapping.

Multipath correlations in underwater acoustic communication channels

Uncorrelated scattering (US), which assumes that multipath arrivals undergo uncorrelated scattering and are thus uncorrelated, has been the standard model for digital communications including underwater acoustic communications. This paper examines the cross-correlation of multipath arrivals based on at-sea data with different temporal coherence time, assuming quasi-stationary statistics. It is found that multipath arrivals are highly cross-correlated when the channel is temporally coherent, and are uncorrelated when the channel is temporally incoherent. A theoretical model based on the path phase rates and relative-phase fluctuations is used to explain experimentally observed phenomena, assuming the path amplitudes vary slowly compared with the phases. The implications of correlated scattering for underwater acoustic communication channel tracking are discussed.

Five-year multicenter study of magnetic attachments used for natural overdenture abutments

The purpose of this study was to examine a longitudinal clinical performance of magnetic attachments used for natural overdenture abutments. The study included 131 patients who had used removable prostheses (complete overdentures 31%, partial dentures 69%) more than 5 years (40-90 years old) with 211 magnetic attachments on natural abutments (Magfit 400 or 600; Aichi Steel co., Aichi, Japan) treated in 15 clinics using a standardized protocol. Analyses were performed on the degree of patient satisfaction regarding retention, complications of magnets (corrosion, detachment from denture base), abutments (pain during mastication, periodontal pocket formation, inflammation, mobility), and dentures (fracture etc.). Ninety-seven percent of patients were satisfied with the retention and stability of their dentures. No corrosion of magnet was observed, and 19 magnets were detached. Most frequent complication of abutments was periodontal pocket formation (52%), followed by the inflammation (29%), increase in mobility (27%) and pain (4%). Magnetic attachment on natural tooth abutments provided a viable and long-term treatment option.

Clutter reduction using Doppler sonar in a harbor environment

A high frequency experiment was conducted in the Woods Hole Harbor in Massachusetts to evaluate the effectiveness of Doppler sonar for discriminating targets from reverberation. Using a pulsed linear frequency modulated signal, one finds that the matched filtered outputs are filled with high-level discrete backscattered returns, referred to as clutter, which are often confused with the target echo. The high level non-target returns have an amplitude distribution that is heavy-tailed. Using a Doppler-sensitive binary-phase-shift-keying signal coded with an m-sequence, the target echo and clutter can be separated by Doppler and delay, and tracked using the Doppler spectrogram (Dopplergram). The Doppler filtered time series show a background reverberation with a Rayleigh-like amplitude distribution, with an improved signal-to-(peak) reverberation ratio compared with that without Doppler filtering. The reduced reverberation level with Doppler processing decreases the probability of false alarm (Pfa) for a given threshold level. Conversely, for a given Pfa, the higher signal-to-(peak) reverberation ratio implies a higher probability of detection. Transmission loss measurement was conducted to estimate some of the system parameters, e.g., the source level and target strength relative to the noise level.

Temporal coherence of acoustic rays and modes using the path integral approach

Acoustic propagation can be described by rays and normal modes. Applying the path integral to refractive rays in three dimensional space, Dashen et al. [J. Acoust. Soc. Am. 77, 1716-1722 (1985)] derived the mutual coherence function of the acoustic field. For shallow water where sound interacts with boundaries, the acoustic field can be described by vertical modes and horizontal rays. Applying the path integral to the horizontal rays, one obtains the mutual coherence function of the normal modes. This paper applies this formulation to the derivation of the temporal coherence function of individual modes and also that of the acoustic field in the presence of linear internal waves. The effects of mode coupling due to internal waves on temporal coherence loss are illustrated with numerical calculations.

Properties of underwater acoustic communication channels in shallow water

Underwater acoustic channels are band-limited and reverberant, posing many obstacles to reliable, phase-coherent acoustic communications. While many high frequency communication experiments have been conducted in shallow water, few have carried out systematic studies on the channel properties at a time scale relevant for communications. To aid communication system design, this paper analyzes at-sea data collected in shallow water under various conditions to illustrate how the ocean environments (sea surface waves and random ocean medium) can affect the signal properties. Channel properties studied include amplitude and phase variations, and temporal coherence of individual paths as well as the temporal and spatial coherence of multipaths at different time scales. Reasons for the coherence loss are hypothesized.

Relating the performance of time-reversal-based underwater acoustic communications in different shallow water environments

The performance of underwater acoustic communications, such as the output signal-to-noise ratio (OSNR), is generally dependent on the channel specifics, hence a channel model is normally required as the performance of the channel equalizer depends on the number of tap coefficients used (e.g., a sparse equalizer) which are different for different oceans having different multipath arrivals. This letter presents theoretical arguments, and experimental data from different oceans that suggest that the increase of OSNR with the number of diverse receivers (in terms of the effective number of receivers) and the decrease of OSNR with the channel-estimation error follow a universal relationship using the time-reversal or correlation-based equalizer, despite the fact that the channels have very different properties. The reason is due to the fact that the OSNR is a function of the q function, the auto-correlation of the received impulse responses summed over all receiver channels, and the q function is approximately the same for all shallow waters given a sufficient (≥4-6) number of receivers.

Linkage of some trace elements, peripheral blood lymphocytes, inflammation, and oxidative stress in patients undergoing either hemodialysis or peritoneal dialysis

BACKGROUND

Changes in essential trace elements may affect the inflammatory and immunological state of patients on hemodialysis (HD) or peritoneal dialysis (PD). Therefore, we aimed to determine trace element content and markers of oxidative stress, inflammation, and immune status in HD and PD patients and to assess the relationships among these parameters.

METHODS

Patients on either HD (n = 20) or PD (n = 20) and age-, sex-, body mass index-matched healthy individuals (n = 20) were enrolled in the study. The trace elements zinc, copper, selenium, and iron; markers of oxidative stress thiobarbituric acid reactive substances (TBARS) and protein carbonyl levels; activities of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase; percentages of CD3 T lymphocytes and the subsets CD4 and CD8; the CD4/CD8 ratio; and C-reactive protein (CRP) were measured.

RESULTS

All dialysis patients had low levels of albumin and hemoglobin. Significantly decreased percentages of CD3 and CD4 T lymphocytes and increased levels of CRP, TBARS, and carbonyl compounds were observed in HD patients. HD patients also had elevated erythrocyte SOD, lower GPx and catalase activities, and decreased levels of Se, Zn, and Fe in comparison to PD patients and healthy subjects. In addition, CRP was positively associated with TBARS and carbonyl levels, but was significantly inversely associated with Zn and Se levels. Positive correlations were found between T lymphocyte CD3 and CD4 percentages and Zn, Se, and Fe levels.

CONCLUSIONS

There were significant decreases in T lymphocyte-related immunological regulation and increased inflammation and oxidative stress in dialysis patients. Essential trace element status was independently related to immune status, inflammation, and oxidative damage.

Interference suppression for code-division multiple-access communications in an underwater acoustic channel

In a code-division multiple-access communications network, the signal from a nearby user often creates a strong interference for the signal from a distant user. This is known as the near-far problem. Power control of source levels is ineffective in an underwater acoustic channel due to the slow sound speed. Interference rejection based on code orthogonality is ineffective using matched-filter processing due to the fact that multipath arrivals effectively destroy the code orthogonality and that the signal arrival times between different users are not synchronized. An algorithm, called hyperspace cancellation by coordinate zeroing, is used in this paper to remove/suppress interference. Using a fast Walsh-Hadamard transform (FWHT) based on the interferer's code sequence, the interference signal is enhanced and removed by coordinate zeroing. The residual signal is transformed back using an inverse FWHT. The filtered data, with the interference signal largely removed, are processed using the desired signal code sequence. Two methods previously developed for direct-sequence spread-spectrum communications in an underwater channel are used to extract the transmitted symbols. Low bit error rate (<10(-2)) is found with the at-sea data for signal-to-interference ratio as low as -8 to -11 dB.

Detection of a novel HLA-B27 allele, B*2740, in Taiwanese volunteer bone marrow donors by sequence-based typing: curiosity rewarded

We report here a novel HLA-B allele, B*2740, discovered in Taiwanese volunteer marrow donors. The new sequence has nucleotide variation at position 527 (T-->A) as compared to B*2708. The nucleotide change caused an amino acid substitution from valine (V) to glutamic acid (E) at codon 152. Since B*2740 carries sequence confers to HLA-Bw6 public epitope we believe that this novel B*27 allele might have been generated from a gene conversion involving a Bw4-specific allele (probably B*2704) and a Bw6-specific allele.

Low probability of detection underwater acoustic communications using direct-sequence spread spectrum

Direct-sequence spread spectrum is used for underwater acoustic communications between nodes, at least one of which is moving. At-sea data show that the phase change due to source motion is significant: The differential phase between two adjacent symbols is often larger than the phase difference between symbols. This poses a challenge to phase-detection based receiver algorithms when the source or receiver is moving. A pair of energy detectors that are insensitive to the phase fluctuations is proposed, whose outputs are used to determine the relationship between adjacent symbols. Good performance is achieved for a signal-to-noise ratio (SNR) as low as -10 dB based on at-sea data. While the method can be applied to signaling using short code sequences, the focus in this paper is on long code sequences for the purpose of achieving a high processing gain (at the expense of a low data rate), so that communications can be carried out at a low input SNR to minimize the probability of detection (P(D)) by an interceptor. P(D) is calculated for a typical shallow water environment as a function of range for several source levels assuming a broadband energy detector with a known signal bandwidth.

Temporal coherence of sound transmissions in deep water revisited

This paper examines the signal coherence loss due to internal waves in deep water in terms of the signal coherence time and compare to data reported in the literature over the past 35 years. The coherence time of the early raylike arrivals was previously modeled by Munk and Zachariasen ["Sound propagation through a fluctuating stratified ocean: Theory and observation," J. Acoust. Soc. Am. 59, 818-838 (1976)] using the supereikonal approximation and by Dashen et al. ["Path-integral treatment of acoustic mutual coherence functions for arrays in a sound channel," J. Acoust. Soc. Am. 77, 1716-1722 (1985)] using the path integral approach; a -1 [corrected] power frequency dependence and a -1/2 [corrected] power range dependence were predicted. Recent data in shallow water in downward refractive environments with internal waves suggested that the signal coherence time of the mode arrivals follows a -3/2 power frequency dependence and a -1/2 power range dependence. Since the temporal coherence of the acoustic signal is related to the temporal coherence of the internal waves, based on the observation that the (linear) internal waves in deep and shallow waters have a similar frequency spectrum, it is argued that the modelike arrivals in deep water should exhibit a similar frequency dependence in deep and shallow waters. This argument is supported by a brute-force application of the path integral to mode arrivals based on the WKB relation between the ray and mode. It is found that the data are consistent with the -3/2 power frequency dependence but more data are needed to further test the hypothesis.

Performance analysis of direct-sequence spread-spectrum underwater acoustic communications with low signal-to-noise-ratio input signals

Direct-sequence spread-spectrum signals collected from the TREX04 experiment are analyzed to determine the bit-error-rate (BER) as a function of the input signal-to-noise ratio (SNR) for a single receiver. A total of 1160 packets of data are generated by adding ambient noise data collected at sea to the signal data (in postprocessing) to create signals with different input-SNR, some as low as -15 dB. Two methods are analyzed in detail, both using a time-updated channel impulse-response estimate as a (matched) filter to mitigate the multipath-induced interferences. The first method requires an independent estimate of the time-varying channel impulse-response function; the second method uses the channel impulse-response estimated from the previous symbol as the matched filter. The first method yields an average BER <10(-2) for input-SNR as low as -12 dB and the second method yields a similar performance for input-SNR as low as -8 dB. The measured BERs are modeled using the measured signal amplitude fluctuation statistics and processing gain obtained by de-spreading the received signal with the transmitted code sequence. Performance losses caused by imprecise symbol synchronization at low input-SNR, uncertainty in channel estimation, and signal fading are quantitatively modeled and compared with data.

Subbottom profiling using a ship towed line array and geoacoustic inversion

Bottom profiling traditionally uses broadband signals received on a line array at long ranges to estimate the bottom layer structure and thickness. In this paper, a subbottom profiling method is developed and applied to a ship-towed line array using the same ship towed source to estimate the subbottom layer structure and thickness. A ship towed line-array system can be used to estimate bottom properties using geoacoustic inversion and can cover a wide area in a short time. It needs some prior information about the subbottom structure and layer thickness, without which the solution can be ambiguous and even erratic when resolving parameters over a wide area. It is shown that the required subbottom information can be obtained from the time-angle relation by beamforming the same acoustic signal data used for geoacoustic inversion. The time-angle analysis is used to expose the prevalent physics intrinsic to geoacoustic inversion. One finds that the tau-p relation of the bottom and the bottom reflection coefficients, sampled at discrete angles associated with bottom and multiple surface-bottom returns, are often adequate, for many practical applications, to uniquely determine the geoacoustic bottom at low (< or =1 kHz) frequencies.

Single- and multi-channel underwater acoustic communication channel capacity: a computational study

Acoustic communication channel capacity determines the maximum data rate that can be supported by an acoustic channel for a given source power and source/receiver configuration. In this paper, broadband acoustic propagation modeling is applied to estimate the channel capacity for a time-invariant shallow-water waveguide for a single source-receiver pair and for vertical source and receiver arrays. Without bandwidth constraints, estimated single-input, single-output (SISO) capacities approach 10 megabitss at 1 km range, but beyond 2 km range they decay at a rate consistent with previous estimates by Peloquin and Leinhos (unpublished, 1997), which were based on a sonar equation calculation. Channel capacities subject to source bandwidth constraints are approximately 30-90% lower than for the unconstrained case, and exhibit a significant wind speed dependence. Channel capacity is investigated for single-input, multi-output (SIMO) and multi-input, multi-output (MIMO) systems, both for finite arrays and in the limit of a dense array spanning the entire water column. The limiting values of the SIMO and MIMO channel capacities for the modeled environment are found to be about four times higher and up to 200-400 times higher, respectively, than for the SISO case. Implications for underwater acoustic communication systems are discussed.

Ocular Toxicity of Intravitreal Indocyanine Green

We report 6 cases of indocyanine green (ICG)-related ocular toxicity after intravitreal ICG usage. Five cases had preoperative diagnosis of macular hole, 1 case had preoperative rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. All cases received vitrectomy, ICG-assisted internal limiting membrane (ILM) peeling and air-fluid exchange. All eyes had residual ICG left at the end of surgery. Patients were followed up with indirect ophthalmoscopy, visual acuity, color fundus photography, fluorescein angiography, and ocular coherence tomography. Circular foveal retinal pigment epithelium atrophy larger than the area of macular hole and surrounding cuff was noted in 4 of 5 cases with preoperative macular hole. The other eye with preoperative diagnosis of macular hole had shallow anterior chamber and low intraocular pressure lasting for 1 week postoperatively. Diffuse retinal pigment epithelial atrophy was noted in the eye with preoperative proliferative vitreoretinopathy. Four eyes demonstrated optic atrophy postoperatively. Ocular toxicity caused by ICG may present as pigment epithelial atrophy, which is characteristically larger than the previous area of macular hole and surrounding cuff. Disc atrophy, retinal toxicity, and ocular hypotony were also observed in some cases. To prevent toxicity, residual ICG and ICG-stained ILM must be removed as completely as possible.

Retinal toxicity of intravitreal tissue plasminogen activator: case report and literature review

OBJECTIVE

To present the clinical picture of retinal toxicity of commercial tissue plasminogen activator (tPA).

DESIGN

Case report and literature review.

METHODS

Two successive intravitreal injections of tPA (50 micro g) 3 days apart with gas tamponade were given to treat a 49-year-old man with submacular hemorrhage. The adverse consequences of this treatment were monitored. A literature review of retinal toxicity of commercial tPA in animals was also done.

MAIN OUTCOME MEASURES

Retinal findings, electroretinograph (ERG) and visual acuity testing.

RESULTS

Diffuse pigmentary alterations sparing the posterior pole, poor visual acuity after the absorption of submacular hemorrhage, reduced scotopic and photopic ERG A- and B-waves were noted.

CONCLUSIONS

This is the first reported case of retinal toxicity of commercial tPA in humans that resembles the descriptions of tPA-mediated retinal toxicity in animal models. The dosage of intravitreal tPA (between 50 and 100 micro g) may be toxic to the human retina.

Beam intensity striations and applications

The single-element spectrogram for a continuous broadband signal, plotted as a function of range, has been shown to exhibit striated bands of intensity maxima and minima. The slope of the striations is an invariant of the modal interference and is described by a waveguide invariant parameter "beta." The striation pattern is analyzed and modeled in this paper for the beam outputs of a horizontal line array obtained by conventional beamforming. Array beamforming makes it possible to measure the waveguide invariant parameter for weak signals due to the enhancement of signal levels by the array gain over that of a single element. It is shown that the signal beam spectrogram as a function of range exhibits the same striation pattern as that (predicted) for a single element. Specifically, for a broadside signal, the beam striation is identical to that of a single-element plus a constant signal gain. For a nonbroadside target, the signal beam intensity will be modified by a frequency-bearing dependent signal gain due to the signal spread over multiple beams, nevertheless the beam spectrogram retains the same striation pattern (slope) as for a single element. The sidelobe beams (outside the canonical cones containing the signal arrivals) exhibit an entirely different striation pattern as a function of frequency and range. For array processing, it is shown that a fast range-rate, close range target and a distant, slow range-rate interference source will have a different striation pattern (slope) in the corresponding beam spectrograms as a function of time, assuming no prior knowledge of the source ranges. The difference in the striations between the beam spectrograms can be used in array processing to suppress the interference contribution. A 5-7 dB interference suppression is demonstrated using simulated data.

Motion compensation for adaptive horizontal line array processing

Large aperture horizontal line arrays have small resolution cells and can be used to separate a target signal from an interference signal by array beamforming. High-resolution adaptive array processing can be used to place a null at the interference signal so that the array gain can be much higher than that of conventional beamforming. But these nice features are significantly degraded by the source motion, which reduces the time period under which the environment can be considered stationary from the array processing point of view. For adaptive array processing, a large number of data samples are generally required to minimize the variance of the cross-spectral density, or the covariance matrix, between the array elements. For a moving source and interference, the penalty of integrating over a large number of samples is the spread of signal and interference energy to more than one or two eigenvalues. The signal and interference are no longer clearly identified by the eigenvectors and, consequently, the ability to suppress the interference suffers. We show in this paper that the effect of source motion can be compensated for the (signal) beam covariance matrix, thus allowing integration over a large number of data samples without loss in the signal beam power. We employ an equivalent of a rotating coordinate frame to track the signal bearing change and use the waveguide invariant theory to compensate the signal range change by frequency shifting.

Space radiation absorbed dose distribution in a human phantom

The radiation risk to astronauts has always been based on measurements using passive thermoluminescent dosimeters (TLDs). The skin dose is converted to dose equivalent using an average radiation quality factor based on model calculations. The radiological risk estimates, however, are based on organ and tissue doses. This paper describes results from the first space flight (STS-91, 51.65 degrees inclination and approximately 380 km altitude) of a fully instrumented Alderson Rando phantom torso (with head) to relate the skin dose to organ doses. Spatial distributions of absorbed dose in 34 1-inch-thick sections measured using TLDs are described. There is about a 30% change in dose as one moves from the front to the back of the phantom body. Small active dosimeters were developed specifically to provide time-resolved measurements of absorbed dose rates and quality factors at five organ locations (brain, thyroid, heart/lung, stomach and colon) inside the phantom. Using these dosimeters, it was possible to separate the trapped-proton and the galactic cosmic radiation components of the doses. A tissue-equivalent proportional counter (TEPC) and a charged-particle directional spectrometer (CPDS) were flown next to the phantom torso to provide data on the incident internal radiation environment. Accurate models of the shielding distributions at the site of the TEPC, the CPDS and a scalable Computerized Anatomical Male (CAM) model of the phantom torso were developed. These measurements provided a comprehensive data set to map the dose distribution inside a human phantom, and to assess the accuracy and validity of radiation transport models throughout the human body. The results show that for the conditions in the International Space Station (ISS) orbit during periods near the solar minimum, the ratio of the blood-forming organ dose rate to the skin absorbed dose rate is about 80%, and the ratio of the dose equivalents is almost one. The results show that the GCR model dose-rate predictions are 20% lower than the observations. Assuming that the trapped-belt models lead to a correct orbit-averaged energy spectrum, the measurements of dose rates inside the phantom cannot be fully understood. Passive measurements using 6Li- and 7Li-based detectors on the astronauts and inside the brain and thyroid of the phantom show the presence of a significant contribution due to thermal neutrons, an area requiring additional study.

On-line microdialysis-high-performance liquid chromatographic determination of aniline and 2-chloroaniline in polymer industrial wastewater

Determination of aniline and 2-chloroaniline in polymer industrial wastewater was examined using high-performance liquid chromatography with on-line microdialysis. After dilution, aniline and 2-chloroaniline in the sample were diffused through a cellular dialysis membrane into the perfusion stream under controlled conditions. Conditions for obtaining optimum dialysis efficiency such as flow-rate and polarity modifier in the perfusion stream, pH and added salt in the sample solution, as well as chromatographic conditions were investigated. The results indicate that the dialysis achieved at a sample matrix pH value of 9.5 with 0.1 M NaCl addition, and the perfusate at 10-microl/min flow-rate offered optimum dialysis efficiency. The aniline and 2-chloroaniline were well separated in an acceptable time on a reversed-phase C18 column eluted with 40% aqueous methanol solution at pH 7.0 and 1.0 ml/min flow-rate. The proposed method provided a very simple procedure to determine aniline and 2-chloroaniline in wastewater. Application was illustrated by the analysis of aniline and 2-chloroaniline in wastewater released from a polymer factory.

Radiogenic transformation of human mammary epithelial cells in vitro

Cancer induction by space radiations is a major concern for manned space exploration. Accurate assessment of radiation risk at low doses requires basic understanding of mechanism(s) of radiation carcinogenesis. For determining the oncogenic effects of ionizing radiation in human epithelial cells, we transformed a mammary epithelial cell line (185B5), which was immortalized by benzo(a)pyrene, with energetic heavy ions and obtained several transformed clones. These transformed cells showed growth properties on Matrigel similar to human mammary tumor cells. To better understand the mechanisms of radiogenic transformation of human cells, we systematically examined the alterations in chromosomes and cancer genes. Among 16 autosomes examined for translocations, by using fluorescence in situ hybridization (FISH) technique, chromosomes 3, 12, 13, 15, 16, and 18 appeared to be normal in transformed cells. Chromosomes 1, 4, 6, 8, and 17 in transformed cells, however, showed patterns different from those in nontransformed cells. Southern blot analyses indicated no detectable alterations in myc, ras, Rb, or p53 genes. Further studies of chromosome 17 by using in situ hybridization with unique sequence p53 gene probe and a centromere probe showed no loss of p53 gene in transformed cells. Experimental results from cell fusion studies indicated that the transforming gene(s) is recessive. The role of genomic instability and tumor suppressor gene(s) in radiogenic transformation of human breast cells remains to be identified.

Phonological studies of the new gas-induced agitated reactor using computational fluid dynamics

An ozone-induced agitated reactor has been found to be very effective in degrading industrial wastewater. However, the cost of the ozone generation as well as its short residence time in reactors has restricted its application in a commercial scale. An innovated gas-induced draft tube installed inside a conventional agitated reactor was proved to effectively retain the ozone in a reactor. The setup was demonstrated to significantly promote the ozone utilization rate up to 96% from the conventional rate of 60% above the onset speed. This work investigates the mixing mechanism of an innovated gas-induced reactor for the future scale-up design by using the technique of computational fluid dynamics. A three-dimensional flow model was proposed to compute the liquid-gas free surface as well as the flow patterns inside the reactor. The turbulent effects generated by two 45 degrees pitch-blade turbines were considered and the two phases mixing phenomena were also manipulated by the Eulerian-Eulerian techniques. The consistency of the free surface profiles and the fluid flow patterns proved a good agreement between computational results and the experimental observation.

Microdialysis of salicylic acid from viscous emulsion samples prior to high-performance liquid chromatographic determination

A micro-dialysis method was developed to isolate aqueous salicylic acid from viscous emulsion samples prior to HPLC determination. The optimal conditions for obtaining dialysis efficiency of salicylic acid as well as chromatographic conditions were investigated. Experimental results indicated that the dialysis achieved at pH 2.0 (0.025 M phosphate solution), 0.5 M NaCl addition, and 50-microl/min flow-rate of perfusion stream offered an optimal result. The proposed method provided a simple procedure for isolating salicylic acid from viscous emulsion samples. Application was illustrated by the analysis of salicylic acid in cosmetic products.

Accuracy of sonography in predicting the outcome of fetal congenital diaphragmatic hernia

BACKGROUND

The outcome of congenital diaphragmatic hernia (CDH) remains poor despite recent advances in neonatal care. This study was designed to evaluate the role of sonography in predicting the outcome of CDH.

METHODS

Pregnancies with CDH were studied. Fetal survival, morbidity, combined anomalies and mortality were recorded. Seven parameters were recorded, including the presence of hydramnios, side of herniation, cardiac deviation, stomach presence, gestational age at the time of finding the CDH and time of postpartum herniorrhaphy. The predictive values of these parameters for fetal outcome were analyzed.

RESULTS

A total of 31 pregnancies were studied. There were 11 cases (35.5%) of termination, seven cases (22.6%) of perinatal death, four cases (12.9%) of late death and nine cases of survival (29%). The survivor group included four cases (44.4%) of complete recovery and five cases (55.6%) with persistent morbidity. There were 15 cases of simple CDH including eight cases of cardiac anomalies (ventricular-septal defect, atrial-septal defect, patent ductus arteriosus and ventricular dilatation). There were eight cases with severe anomalies (3 with trisomy 18, 2 with Cantrell's pentalogy, 1 with trisomy 13, 1 with cystic hygroma and one with Tetralogy Fallot). Among the seven parameters studied, gestational age at the time of finding the CDH and hydramnios were related to fetal survival.

CONCLUSIONS

Sonography assists in predicting the postnatal outcome of CDH. Diagnosis of CDH at less than 25 weeks' gestation and the existence of hydramnios are associated with higher mortality. Postnatal therapy and prenatal surgical intervention are necessary to salvage fetuses in the presence of these two situations. The survival rate of infants with CDH was 45%. Of these, 55.6% had persistent morbidity. Prenatal counseling should reflect this.

Gender prevalence in twin-twin transfusion syndrome

BACKGROUND

This study aimed to determine the gender prevalence of fetuses complicated with twin-twin transfusion syndrome (TTTS).

METHODS

All cases of TTTS corresponded with the following major criteria: a single placenta, monochorion, the same gender, and a combination of polyhydramnios-oligohydramnios. At least one of three minor criteria were required for the establishment of TTTS, including a stuck twin, a birth weight discordance exceeding 20%, and hemoglobin difference > 5 g/dl.

RESULTS

Fifty-six twin pregnancies met the above criteria, of which 33 (58.9%) twin pairs were female. The female tendency existed, but there was a non-significant difference. Mean gestational age at diagnosis was 20.2 +/- 3.2 weeks. The birth weight discordance exceeding 20% was present in 50 of 56 (89.3%), and mean growth discordance was 32% +/- 8%. A stuck twin was noted in 37 of 56 cases (66.1%). The mortality of fetuses or neonates was 34.8% (39/112), including 8 (7.1%) fetal deaths and 31 (27.6%) neonatal deaths. There were no differences in maternal age, parity, or gestational age of delivery between male and female pregnancies.

CONCLUSION

Although the female preponderance did not reach statistical significance, the female tendency might still exist after a larger series analysis. The female tendency may be the result of the gender difference in monochorionic twins. The gender difference could provide research implications and a diagnostic warning for clinicians in monochorionic twin pregnancies before the presence of TTTS.

[Clinical research on arteriovenous internal fistula made by various blood vessels]

OBJECTIVE

To compare the permeability and incidence rate of complication of arteriovenous internal fistula made by autogenous, homologous, and artificial Teflon blood vessels.

METHODS

Two hundred and forty one cases with arteriovenous internal fistula made by autogenous, homologous, and artificial Teflon blood vessels were followed up to compare the permeability and incidence rate of complication at 6 months, 1 year, 3 years, and 5 years.

RESULTS

The incidence rate of complication of autogenous blood vessels was lowest, it had no statistical differences compared with arteriovenous internal fistula made by homologous blood vessels. The permeability of arteriovenous internal fistula made by homologous blood vessels was highest, and it had no statistical differences compared with autogenous blood vessels. The permeability of arteriovenous internal fistula made by artificial Teflon blood vessels was lowest, but the incidence rate of complication was highest, and it had significantly statistical differences compared with arteriovenous internal fistula made by autogenous blood vessels (P < 0.01).

CONCLUSION

Arteriovenous internal fistulas made by autogenous and homologous blood vessels have high permeability and low incidence rate of complication, they are superior to the arteriovenous internal fistula made by artificial Teflon blood vessels.